Prediction of poor outcome in Clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle

Classification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thres...

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Published in:	Anaerobe Vol. 61; p. 102079
Main Authors:	Reigadas, E., Alcalá, L., Marín, M., Martin, A., Muñoz, P., Bouza, E., Sánchez-Arroyo, Rafael J., Azcona-Gutiérrez, José Manuel, García-García, Concepción, Fernández-Caso, Belén, García-Blanco, Alicia, Fernandez-Pittol, Mariana, Álvarez-Martínez, Míriam José, Orellana Miguel, M. Ángeles, Nuño, Enrique Muñoz, Álvarez-Paredes, Ledicia, Megías, Gregoria, Medrano, Ramiro López, Foz, Carlos Fuster, Leiva, José, Fernández-Alonso, Mirian, Vega, Silvia, Hernando, Susana, de Frutos, Mónica, Eiros, José María, Trujillo, Gloria, López, Joan, Molina de Diego, Araceli N., López Hontangas, José Luis, Guerrero-Vadillo, María
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-02-2020
Subjects:	Amplification cycle Clostridioides difficile infection Predictors Recurrence Toxin b quantitation Recurrence Clostridioides difficile infection Amplification cycle Predictors Toxin b quantitation
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Summary:	Classification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thresholds (Ct) were independently associated with poor outcome CDI. Our objective was to perform a multicentre external validation of a PCR-toxin B Ct as a marker of poor outcome CDI. We carried out a multicentre study (14 hospitals) in which the characteristics and outcome of patients with CDI were evaluated. A subanalysis of the results of the amplification curve of real-time PCR gene toxin B (XpertTM C. difficile) was performed. A total of 223 patients were included. The median age was 73.0 years, 50.2% were female, and the median Charlson index was 3.0. The comparison of poor outcome and non–poor outcome CDI episodes revealed, respectively, the following results: median age (years), 77.0 vs 72.0 (p = 0.009); patients from nursing homes, 24.4% vs 10.8% (p = 0.039); median leukocytes (cells/μl), 10,740.0 vs 8795.0 (p = 0.026); and median PCR-toxin B Ct, 23.3 vs 25.4 (p = 0.004). Multivariate analysis showed that a PCR-toxin B Ct cut-off <23.5 was significantly and independently associated with poor outcome CDI (p = 0.002; OR, 3.371; 95%CI, 1.565–7.264). This variable correctly classified 68.5% of patients. The use of this microbiological marker could facilitate early selection of patients who are at higher risk of poor outcome and are more likely to benefit from newer and more costly therapeutic options. •Patients with poor outcome CDI presented lower PCR toxin B amplification Ct•When cut-off (<23.5Ct) was applied we found independent association with poor outcome•We successfully stratified nearly 70% of patients with poor outcome CDI
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1075-9964 1095-8274
DOI:	10.1016/j.anaerobe.2019.102079